Unexpected Cardiac Arrest Research Articles

Unexpected pulmonary edema and cardiac arrest following wedge resection of spontaneous pneumothorax -A case report-

BackgroundReexpansion pulmonary edema is a rare but potentially lethal complication. We report a case of suspected reexpansion pulmonary edema that led to cardiac arrest.CaseA 16-year-old male patient underwent wedge resection due to right pneumothorax. The patient showed pink frothy sputum three hours following surgery, and a chest x-ray showed right unilateral pulmonary edema. Thirteen hours following surgery, the patient continuously showed pink frothy sputum and presented with severe hypoxemia, tachypnea, and tachycardia. After transferring to the intensive care unit (ICU), he developed ventricular tachycardia. Cardiopulmonary resuscitation was performed for 32 min. Chest X-ray showed diffuse bilateral pulmonary edema. Extracorporeal membrane oxygenation was performed. During the 65 days of ICU care, the patient became mentally alert. However, follow-up echocardiography revealed severe heart failure.ConclusionsRexpansion pulmonary edema can rapidly progress to diffuse bilateral pulmonary edema. Therefore, careful observation is required for the patients who show signs of pulmonary edema after reexpansion.

Incidence and Outcomes of Cardiopulmonary Resuscitation in ICUs: Retrospective Cohort Analysis.

We aim to describe incidence and outcomes of cardiopulmonary resuscitation (CPR) efforts and their outcomes in ICUs and their changes over time. Retrospective cohort analysis. Patient data documented in the Austrian Center for Documentation and Quality Assurance in Intensive Care database. Adult patients (age ≥ 18 yr) admitted to Austrian ICUs between 2005 and 2019. None. Information on CPR was deduced from the Therapeutic Intervention Scoring System. End points were overall occurrence rate of CPR in the ICU and CPR for unexpected cardiac arrest after the first day of ICU stay as well as survival to discharge from the ICU and the hospital. Incidence and outcomes of ICU-CPR were compared between 2005 and 2009, 2010 and 2014, and 2015 and 2019 using chi-square test. A total of 525,518 first admissions and readmissions to ICU of 494,555 individual patients were included; of these, 72,585 patients (14.7%) died in hospital. ICU-CPR was performed in 20,668 (3.9%) admissions at least once; first events occurred on the first day of ICU admission in 15,266 cases (73.9%). ICU-CPR was first performed later during ICU stay in 5,402 admissions (1.0%). The incidence of ICU-CPR decreased slightly from 4.4% between 2005 and 2009, 3.9% between 2010 and 2014, and 3.7% between 2015 and 2019 ( p < 0.001). A total of 7,078 (34.5%) of 20,499 patients who received ICU-CPR survived until hospital discharge. Survival rates varied slightly over the observation period; 59,164 (12.0%) of all patients died during hospital stay without ever receiving CPR in the ICU. The incidence of ICU-CPR is approximately 40 in 1,000 admissions overall and approximately 10 in 1,000 admissions after the day of ICU admission. Short-term survival is approximately four out of 10 patients who receive ICU-CPR.

Effects of immersive virtual reality cardiopulmonary resuscitation training on prospective kindergarten teachers' learning achievements, attitudes and self‐efficacy

Children's unexpected cardiac arrest warrants cardiopulmonary resuscitation (CPR) by kindergarten teachers. Yet, recent research revealed trained personnel reporting poor transfer of acquired skills during real‐world emergencies with conventional CPR training. Immersive virtual reality (IVR) training induces a greater sense of presence and agency than conventional CPR training and may be more effective in terms of increasing trainees' intention and initiative to perform CPR in real‐world emergencies. A quasi‐experiment was conducted to assess the effectiveness of the IVR‐based CPR training method in terms of enhancing the intention to perform CPR. The trial enrolled 50 participants, 25 of whom examined a child patient in an IVR virtual scenario, using an AED, and performed two rounds of two‐minute chest compressions. The remaining 25 participants were trained using a video with consistent content on a monitor. A generalised estimating equation analysis demonstrated that the IVR training method significantly increased prospective kindergarten teachers' self‐efficacy for performing CPR, positive attitudes towards CPR, and CPR knowledge. This advantage was also maintained after the five‐week follow‐up. Thus, CPR teaching via IVR looks to be an excellent way to enhance the intention to perform CPR and may be of great value in improving existing CPR training systems. Practitioner notesWhat is already known about this topic Many trainees who have received traditional cardiopulmonary resuscitation (CPR) training hesitate to perform the skills learned in a real‐world emergency. The critical determinant of whether an individual performs a behaviour is the individual's ‘intention’ to perform that behaviour. Individual's self‐efficacy to perform CPR, attitudes towards CPR, and perceived social norms are three determinants that influence intention to perform CPR. Immersive media such as virtual reality may elicit more attitudinal changes and a greater sense of learner self‐efficacy than current mainstream media. What this paper adds The study's results indicated that compared to conventional technology‐supported video training, immersive virtual reality (IVR) training significantly increased participants' self‐efficacy about performing CPR, positive attitudes towards CPR and CPR knowledge. CPR training through IVR may enhance trainees' intention to perform CPR in real‐world emergencies. Implications for practice and/or policy The effectiveness of combining IVR technology into existing CPR training methods such as mixed reality training, which blends virtual environments with realistic mannequins, should be further examined in the future. IVR may be a more effective medium for enhancing the intention to perform behaviour than conventional technology. Future research could further experiment with the use of IVR as a behavioural intervention technique in education

Increased emergency cardiovascular events among under-40 population in Israel during vaccine rollout and third COVID-19 wave

Cardiovascular adverse conditions are caused by coronavirus disease 2019 (COVID-19) infections and reported as side-effects of the COVID-19 vaccines. Enriching current vaccine safety surveillance systems with additional data sources may improve the understanding of COVID-19 vaccine safety. Using a unique dataset from Israel National Emergency Medical Services (EMS) from 2019 to 2021, the study aims to evaluate the association between the volume of cardiac arrest and acute coronary syndrome EMS calls in the 16–39-year-old population with potential factors including COVID-19 infection and vaccination rates. An increase of 25% was detected in both call types during January–May 2021, compared with the years 2019–2020. Using Negative Binomial regression models, the weekly emergency call counts were significantly associated with the rates of 1st and 2nd vaccine doses administered to this age group but were not with COVID-19 infection rates. While not establishing causal relationships, the findings raise concerns regarding vaccine-induced undetected severe cardiovascular side-effects and underscore the already established causal relationship between vaccines and myocarditis, a frequent cause of unexpected cardiac arrest in young individuals. Surveillance of potential vaccine side-effects and COVID-19 outcomes should incorporate EMS and other health data to identify public health trends (e.g., increased in EMS calls), and promptly investigate potential underlying causes.

Cardiac Tamponade – a Cause of Sudden Death in a Premature Newborn

Background Cardiac tamponade is a potential complication in neonates with central venous catheters (CVC). Cardiac tamponade may be due to infection, a CVC related complication, or parental nutrition (PN) effusion. Case Report This is a preterm (30 weeks gestational age), very low birth weight male, admitted to the Neonatal Intensive Care Unit, requiring nasal continuous positive airway pressure. PN was provided via an umbilical venous catheter. An unexpected cardiac arrest occurred on the third day of life with an unsuccessful resuscitation. Autopsy revealed pericardial effusion composed of PN fluid with cardiac tamponade as the cause of death. Conclusion Cardiac tamponade due to total PN effusion in the premature neonate may be fatal. The mechanism of the epicardial/pericardial effusion is not known.

Early warning systems and rapid response systems for the prevention of patient deterioration on acute adult hospital wards.

Early warning systems and rapid response systems for the prevention of patient deterioration on acute adult hospital wards.

Incidence, clinical characteristics, and outcome after unexpected cardiac arrest among critically ill adults with COVID-19: insight from the multicenter prospective ACICOVID-19 registry

BackgroundInitial reports have described the poor outcome of unexpected cardiac arrest (CA) in intensive care unit (ICU) among COVID-19 patients in China and the USA. However, there are scarce data on characteristics and outcomes of such CA patients in Europe.MethodsProspective registry in 35 French ICUs, including all in-ICU CA in COVID-19 adult patients with cardiopulmonary resuscitation (CPR) attempt. Favorable outcome was defined as modified Rankin scale ranging from 0 to 3 at day 90 after CA.ResultsAmong the 2425 COVID-19 patients admitted to ICU from March to June 2020, 186 (8%) experienced in-ICU CA, of whom 146/186 (78%) received CPR. Among these 146 patients, 117 (80%) had sustained return of spontaneous circulation, 102 (70%) died in the ICU, including 48 dying within the first day after CA occurrence and 21 after withdrawal of life-sustaining therapy. Most of CA were non-shockable rhythm (90%). At CA occurrence, 132 patients (90%) were mechanically ventilated, 83 (57%) received vasopressors and 75 (51%) had almost three organ failures. Thirty patients (21%) had a favorable outcome. Sepsis-related organ failure assessment score > 9 before CA occurrence was the single parameter constantly associated with unfavorable outcome in multivariate analysis.ConclusionsIn-ICU CA incidence remains high among a large multicenter cohort of French critically ill adults with COVID-19. However, 21% of patients with CPR attempt remained alive at 3 months with good functional status. This contrasts with other recent reports showing poor outcome in such patients.Trial registration: This study was retrospectively registered in ClinicalTrials.gov (NTC04373759) in April 2020 (https://www.clinicaltrials.gov/ct2/show/NCT04373759?term=acicovid&draw=2&rank=1).

Association of patient-to-emergency department staff ratio with the incidence of cardiac arrest: A retrospective cohort study

Background: Emergency department (ED) overcrowding and overuse are global healthcare problems. Despite that substantial pieces of literature have explored quality parameters to monitor the patients’ safety and quality of care in the ED, to the best of our knowledge, no reasonable patient-to-ED staff ratios were established. Objectives: This study aimed to find the association between unexpected emergency department cardiac arrest (EDCA) and the patient-to-ED staff ratio. Methods: A retrospective cohort study was conducted in a medical center in Taiwan. Non-trauma patients (age &gt; 18) who visited the ED from January 1, 2016 to November 30, 2018 were included. The total number of patients in ED, number of patients waiting for boarding, length of stay over 48 hours, and physician/nurse number in ED were collected and analyzed. The primary outcome was the association of each parameter with the incidence of EDCA. Results: A total of 508 patients were included. The total number of patients in ED ( &gt; 361, RR: 1.54; 95% CI {1.239-1.917}), ED occupancy rate (&gt; 280, RR: 1.54; 95% CI {1.245-1.898}), ED bed occupancy rate (&gt; 184, RR: 1.63; 95% CI {1.308-2.034}), number of patients waiting for boarding (&gt; 134, RR: 1.45; 95% CI {1.164-1.805}), number of patients in ED with length of stay over 48 hours (&gt; 36, RR: 1.27; 95% CI {1.029-1.558}) and patient-to-nurse ratio (&gt; 8.5, adjusted RR: 1.33; 95% CI {1.054-1.672}) had significant associations with higher incidence of EDCA. However, the patient-to-physician ratio was not associated with EDCA incidence. Discussions: Regarding loading parameters, the patient-to-nurse ratio is more representative than the patient-to-physician ratio as regards association with higher EDCA incidence. Conclusions: A higher patient-to-nurse ratio (&gt; 8.5) was associated with an increment in the incidence of EDCA. Our findings provide a basis for setting different thresholds for different ED settings to adjust ED staff and develop individually tailored approaches corresponding to the level of ED overcrowding.

Incidence of unexpected cardiac arrest among intensive care unit patients in national guard hospitals in Jeddah, Riyadh, and Al Ahsa

Background: Cardiac arrest (CA) is a sudden collapse of cardiac mechanical function as evidenced by the absence of detectable pulse and the absence or gasping of breath, which all combined with a loss of consciousness. Although researches on resuscitation efforts have been increasing significantly recently, little investigations have been done on the incidence of unexpected CA among intensive care unit (ICU) patients, in particular, in Saudi Arabia. Aim: The main goal of this research is to explore the rate and patient characteristics of unexpected CA among in ICU patients in the National Guard Health Affairs hospitals in Jeddah, Riyadh, and Al Ahsa. Materials and Methods: This study was a retrospective analysis of ICU patients who experienced unexpected CA. Settings: The study was conducted at the ICUs of three National Guard hospitals in Saudi Arabia. Results: Findings showed that only 11% of the ICU patients who received cardiopulmonary resuscitation (CPR) had a successful return of spontaneous circulation and the overall mortality rate was 89%. The most common cause of unexpected CA is sepsis, found in 348 out of 1233 patients (28%). The most common medical history accompanied by the ICU patients' medical history is a multi-organ dysfunction, found in 184 out of 1233 (14.9%) patients. We found a weak negative relationship between patients' gender and the causes of unexpected CA (relative risk = −0.069 and P < 0.05). Conclusion: The findings are in line with prior studies confirming that mortality increases when unexpected CA occurs on patients with sepsis. There was no significant relationship seen between patients' age and CPR outcomes.

The optimal threshold for prompt clinical review: An external validation study of the national early warning score.

The aim of this study was to determine the optimal threshold for national early warning score in clinical practice. The national early warning score is an aggregate early warning score aiming to predict patient mortality. Studies validating national early warning score did not use standardised patient outcomes or did not always include clinical workload in their results. Since all patients with a positive national early warning score require a clinical workup, it is crucial to determine the optimal threshold to limit false-positive alerts. An external validation study using retrospectively collected data of patient admissions in six Belgian hospitals. We adhered to the STARD guideline for reporting. Two sample groups were selected: the cross-sectional sample (admitted patients, 1day every 4months) and the serious adverse event sample (all patients with unexpected death, cardiac arrest and unplanned admission to the intensive care unit). The maximum registered national early warning score value was collected in both groups. Predictive values were used as estimates for clinical workload. We collected 1,523 in the cross-sectional sample and 390 patients in the serious adverse event sample. A national early warning score ≥5 had a predictive value of 6.8% and a negative predictive value of 99.5% to predict unexpected death, cardiac arrest with cardiopulmonary resuscitation or unplanned admission to intensive care (AUROC 0.841). The performance of national early warning score differed between outcome measures. Considering the predictive value, the optimal threshold for national early warning score is ≥5. We validated national early warning score to be applied in general hospital wards and confirmed the optimal threshold (≥5). When a patient has a national early warning score <5, we may assume that in the next 24hr this patient is less likely to die unexpectedly, receive cardiopulmonary resuscitation or be transferred to the ICU. Because of the significant number of false positives when national early warning score is ≥5, hospitals should create workable guidelines for clinical practice.

Use of ultra-low cost fitness trackers as clinical monitors in low resource emergency departments.

In low resource hospitals, strained staffing ratios and lack of telemetry can put patients at risk for clinical deterioration and unexpected cardiac arrest. While traditional telemetry systems can provide real-time continuous vital signs, they are too expensive for widespread use in these settings. At the same time, developed countries such as the United States have been increasingly utilizing remote monitoring systems to shift patient care from hospital to home. While the context is dramatically different, the challenge of monitoring patients in otherwise unmonitored settings is the same. At-home monitoring solutions range from highly comprehensive and expensive systems to inexpensive fitness trackers. In the field of global health, the adoption of this technology has been somewhat limited. We believe that low cost fitness trackers present an opportunity to address the challenge of vital sign monitoring in resource-poor settings at a fraction of the cost of existing technical solutions.

Maximum emergency department overcrowding is correlated with occurrence of unexpected cardiac arrest

BackgroundEmergency department overcrowding negatively impacts critically ill patients and could lead to the occurrence of cardiac arrest. However, the association between emergency department crowding and the occurrence of in-hospital cardiac arrest has not been thoroughly investigated. This study aimed to evaluate the correlation between emergency department occupancy rates and the incidence of in-hospital cardiac arrest.MethodsA single-center, observational, registry-based cohort study was performed including all consecutive adult, non-traumatic in-hospital cardiac arrest patients between January 2014 and June 2017. We used emergency department occupancy rates as a crowding index at the time of presentation of cardiac arrest and at the time of maximum crowding, and the average crowding rate for the duration of emergency department stay for each patient. To calculate incidence rate, we divided the number of arrest cases for each emergency department occupancy period by accumulated time. The primary outcome is the association between the incidence of in-hospital cardiac arrest and emergency department occupancy rates.ResultsDuring the study period, 629 adult, non-traumatic cardiac arrest patients were enrolled in our registry. Among these, 187 patients experienced in-hospital cardiac arrest. Overall survival discharge rate was 24.6%, and 20.3% of patients showed favorable neurologic outcomes at discharge. Emergency department occupancy rates were positively correlated with in-hospital cardiac arrest occurrence. Moreover, maximum emergency department occupancy in the critical zone had the strongest positive correlation with in-hospital cardiac arrest occurrence (Spearman rank correlation ρ = 1.0, P < .01). Meanwhile, occupancy rates were not associated with the ED mortality.ConclusionMaximum emergency department occupancy was strongly associated with in-hospital cardiac arrest occurrence. Adequate monitoring and managing the maximum occupancy rate would be important to reduce unexpected cardiac arrest.

The effectiveness of a focused rapid response team on reducing the incidence of cardiac arrest in the general ward.

Rapid response teams have been adopted to prevent unexpected in-ward cardiac arrest. However, there is no convincing evidence of optimal operation with rapid response team. Our aim was to address the impact of focused rapid response team on the safety of patients in wards. Comparison of focused with extended rapid response teams was performed in single center. The extended team operated on adult patients in whole ward (both medical and nonmedical ward) 24 hours per day, 7 days per week during 2012. In 2015, the operational time of the focused team was office hours from Monday to Friday and study population were limited to adult patients in the nonmedical ward. Unexpected in-ward cardiac arrests were compared between the extended team and focused team periods. During the focused team period, there was significant reduction in cardiac arrest per 1000 admissions in whole ward compared to the before the rapid response team period (1.09 vs 1.67, P < .001). Compared to that of the extended team period (1.42), there was also a significant reduction in cardiac arrest rate (P = .04). The cardiac arrest rate of nonmedical ward patients was also significantly decreased in the focused team period compared to that before the rapid response team period (0.43 vs 0.95, P < .001). Compared to the extended team period (0.64), there was a marginally significant reduction in cardiac arrest of nonmedical ward patients (P = .05). The focused rapid response team was associated with a reduced incidence of unexpected in-ward cardiac arrest. Further research on the optimal composition and operational time is needed.

Early Warning System Safeguarding Patient Lives

Disease progression often differs among patients. According to study findings, changes in vital signs, blood oxygen saturation, and consciousness are each related closely to acute deterioration in disease status (Sutherasan et al., 2018). The early warning system (EWS) is a predictive approach to detecting deterioration in disease condition based on the observation of slight variations in patient vital signs and clinical symptoms (Smith et al., 2014). Most patients experience changes in specific physiological variables before experiencing a cardiac arrest. The implementation of a comprehensive EWS facilitates the early identification and prevention of serious adverse events such as unexpected cardiac arrest and death, and may help reduce the risk of other unexpected events as well (Gerry et al., 2017). For medical team members, the use of EWS not only permits the detection of changes in patient condition at an early stage but also allows healthcare workers to respond more proactively and effectively. Moreover, EWS has been shown to improve communication, increase cooperation, and strengthen personal responsibility among healthcare workers (Burns et al., 2018). In summary, implementing EWS allows the prompt initiation of appropriate patient treatment and helps improve patient-care outcomes. While recognizing the importance of incorporating EWS into patient care in clinical and home-based institutions as an important strategy to protecting the lives of patients, appropriate standardized warning systems must be tailored to address different disease characteristics. Changes in patient condition are traditionally addressed through nursing assessment followed by physician notification and response. However, this process may be affected by factors such as assessment accuracy, cultural differences, confidence, and past experiences that may result in decision-making errors (Wood, Chaboyer, & Carr, 2019). The integration of EWS and medical informatics technology is expected to reduce the risks of human-interpretation-related omissions and errors (Downey, Tahir, Randell, Brown, & Jayne, 2017). Although the use of medical informatics technology to enhance EWS remains in its infancy, this will certainly be one of the future trends in patient care. The articles in this issue, in addition to introducing EWS, elucidate the current application of EWS in clinical critical conditions and introduce how informatics technology is being combined in home EWS applications. These articles comprise a rich body of information on EWS that may referenced in clinical nursing care, home care, education, and research.

Culture and personal influences on cardiopulmonary resuscitation- results of international survey

BackgroundThe ethical principle of justice demands that resources be distributed equally and based on evidence. Guidelines regarding forgoing of CPR are unavailable and there is large variance in the reported rates of attempted CPR in in-hospital cardiac arrest. The main objective of this work was to study whether local culture and physician preferences may affect spur-of-the-moment decisions in unexpected in-hospital cardiac arrest.MethodsCross sectional questionnaire survey conducted among a convenience sample of physicians that likely comprise code team members in their country (Indonesia, Israel and Mexico). The questionnaire included details regarding respondent demographics and training, personal value judgments and preferences as well as professional experience regarding CPR and forgoing of resuscitation.ResultsOf the 675 questionnaires distributed, 617 (91.4%) were completed and returned. Country of practice and level of knowledge about resuscitation were strongly associated with avoiding CPR performance. Mexican physicians were almost twicemore likely to forgo CPR than their Israeli and Indonesian/Malaysian counterparts [OR1.84 (95% CI 1.03, 3.26), p = 0.038]. Mexican responders also placed greater emphasison personal and patient quality of life (p < 0.001). In multivariate analysis, degree of religiosity was most strongly associated with willingness to forgo CPR; orthodox respondents were more than twice more likely to report having forgone CPR for apatient they do not know than secular and observant respondents, regardless of the country of practice [OR 2.12 (95%CI 1.30, 3.46), p = 0.003].ConclusionsIn unexpected in-hospital cardiac arrest the decision to perform or withhold CPR may be affected by physician knowledge and local culture as well as personal preferences. Physician CPR training should include information regarding predictors of patient outcome at as well as emphasis on differentiating between patient and personal preferences in an emergency.

Total neoadjuvant treatment of locally advanced rectal cancer with high risk factors in Slovenia.

BackgroundIn the light of a high rate of distant recurrence and poor compliance of adjuvant chemotherapy in high risk rectal cancer patients the total neoadjuvant treatment was logical approach to gaining acceptance. We aimed to evaluate toxicity and efficiency of this treatment in patients with rectal cancer and high risk factors for local or distant recurrence.Patients and methodsPatients with rectal cancer stage II and III and with at least one high risk factor: T4, presence of extramural vein invasion (EMVI), positive extramesorectal lymph nodes or mesorectal fascia (MRF) involvement were treated with four cycles of induction CAPOX/FOLFOX, followed by capecitabine-based radiochemotherapy (CRT) and two consolidation cycles of CAPOX/FOLFOX before the operation. Surgery was scheduled 8–10 weeks after completition of CRT.ResultsFrom November 2016 to July 2018 66 patients were evaluable. All patients had stage III disease, 24 (36.4%) had T4 tumors, in 46 (69.7%) EMVI was present and in 47 (71.2%) MRF was involved. After induction chemotherapy, which was completed by 61 (92.4%) of patients, radiologic downstaging of T, N, stage, absence of EMVI or MRF involvement was observed in 42.4%, 62.1%, 36.4%, 69.7% and 68.2%, respectively. All patients completed radiation and 54 (81.8%) patients received both cycles of consolidation chemotherapy. Grade 3 adverse events of neoadjuvant treatment was observed in 4 (6%) patients. Five patients rejected surgery, 3 of them with radiologic complete clinical remissions. One patient did not have definitive surgery of primary tumor due to unexpected cardiac arrest few days after sigmoid colostomy formation. Among 60 operated patients pathological complete response rate was 23.3%, the rate of near complete response was 20% and in 96.7% radical resection was achieved. Pathological T, N and stage downstaging was 65%, 96.7% and 83.4%, respectively. Grade ≥ 3 perioperative complications were anastomotic leakage in 3, pelvic abscess in 1 and paralytic ileus in 2 patients. The rate of pathologic complete response (pCR) in patients irradiated with 3D conformal technique was 12.1% while with IMRT and VMAT it was 37% (p < 0.05). Hypofractionation with larger dose per fraction and simultaneous integrated boost used in the latest two was the only factor associated with pCR.ConclusionsTotal neoadjuvant treatment of high risk rectal cancer is well tolerated and highly effective with excellent tumor and node regression rate and with low toxicity rate. Longer follow up will show if this strategy will improve distant disease control and survival.

A Study to Assess the Effectiveness of Simulation in terms of Knowledge and Skill Regarding Basic Life Support (BLS) Among Non-Medical Faculty. - A Narrative Review.

Cardiac arrest, (is also known as circulatory arrest) is the cessation of normal circulation of the blood due to failure of the heart to contract effectively. Arrested blood circulation prevents delivery of oxygen to the body. Lack of oxygen to the brain causes loss of consciousness, which then result in abnormal or absent breathing. When unexpected cardiac arrest leads to death this is called sudden cardiac death. The treatment for cardiac arrest is cardiopulmonary resuscitation (CPR) to provide circulatory support. The aim of this narrative review is to find information on the effectiveness of simulation in terms of knowledge and skill regarding basic life support among non-medical faculty (participants). Intervention-Simulation on Basic life support method was used in the study. Quasi experimental study with skill lab of College was used in the study. This narrative review result has appeared that simulation will be effective for acquiring knowledge and skills on basic life support.

Unexpected intraoperative cardiac arrest – an unexpected happy end

Introduction: Perioperative cardiac arrest incidence varies from 4.3-34.6/10,000 (1). This situation develops due to physiologic effects of the surgical procedure, unwanted organ and venous injury, anesthetic medications or comorbidities.

Sequential Single Lung Transplant (SLT) with or without Ex-Vivo Lung Perfusion Maximizes on Donor to Transplant Conversion Rates

Purpose A double lung donor may be split, with a single lung transplanted sequentially into two different recipients by one team. This minimizes utilization of hospital staff resources, day time theater access and supports donor to transplant conversion rates. This is a retrospective institutional review of the first 12 cases assessing the impact of extended ischemic time (for the delayed second lung transplant recipient) on length of stay (LOS), intermediate term graft function and survival. Methods Twelve sequential single lung transplants were performed from 6 donors between August 2016 and September 2017. Basic data for donors and recipients including outcomes (ischemic time, ICU stay, total hospital stay, 30 day mortality, 12-month survival including pulmonary function tests (PFTs)) were recorded. Borderline lungs were implanted to the EVLP circuit and reperfused using acellular supplemented Steen Solution (Vitrolife, Goteborg, Sweden). Recipients were categorized into 2 groups: G1 for patients who received the 1st lung, hence having a shorter ischemic time (whether they had EVLP or not), G2 for patients who received the 2nd lung, hence a longer ischemic time. 3 patients received EVLP reconditioned lungs. Results Donor data (n = 6) were: age, 44.2 ± 8.33 years; female/male, 5:1; cause of death: intracranial haemorrhage 4(66.6%), hypoxic brain injury 1(16.6%) and traumatic brain injury 1(16.6%). Mean LAS Score was similar for both groups (44.9 G1 and 41.7 G2, p value=0.64). Mean ischemic time from donor cross clamp to reperfusion was 389 minutes for G1 and 708 minutes for G2. There was no significant difference in ICU stay: 14.7 days vs 6.0 days with a quicker discharge from ITU in the G2(p value=0.20). The mean Hospital LOS was 32.3 vs 20.3 days, (p value= 0.35) Mean FEV1 at 3 months in G1 was 2.4 L (79.7%) and in G2 was 2.0 L (68.4%) (p value=0.38). No all cause 30 day mortality in both groups. At 1-year 2 patients had died from an unexpected bradycardic cardiac arrest. Conclusion SLT if limited resources are available maximize on donor to transplant conversion rates. Donor ischemic lung time is not a deterrent in the era of EVLP. SLT into two recipients by a single theater service is feasible, cost-effective and safe.

Initial Experience with Non-Perfused Organ Donors for Lung Transplantation

Purpose Uncontrolled donation after death by circulatory criteria (uDCD) has the potential to alleviate some of the shortage of suitable lungs for transplantation. Non-Perfused Organ Donors (NPOD) differs from uDCD donors in that only lungs are obtained as no reperfusion is instituted after individuals suffer an unexpected sudden cardiac arrest. Family are approached rapidly by trained coordinators for consent to donate lungs. This study reviews our initial experience and challenges with NPOD donation. Methods Data were collected from donors and recipients involved in NPOD lung transplants between February 2016 and October 2018. We describe NPOD donor volumes, ischemia time, utilization rates, length of intensive care unit (ICU) and hospital stay, and survival. Results There were 101 referrals during this period. Of the 34 approached for donation, consent was obtained in 24 cases, and the lung transplant team evaluated 24 NPOD donors on site. Eleven donors were declined before retrieval because of medically unsuitable lungs, and 4 donors were declined after retrieval due to severe lung injury on site. Nine lungs underwent ex vivo lung perfusion in order to evaluate suitability for transplantation and eventually 3 were used for transplantation. Thus, the total utilization rate from consented donors was 12.5%. The mean warm ischemic time was 160 minutes (range: 106-175 minutes). The mean age of 3 recipients was 48 ± 2.5 years. The 30-day mortality was 0%. One patient bridged to transplantation on extracorporeal membrane oxygenation (ECMO) was kept on ECMO for 5 days after transplant. Median ICU stay was 20 days (range: 5-78 days). Median hospital stay was 47 days (range: 18-100 days). Two out of 3 patients are alive at a median of 716 days (range: 100-936 days) with good performance status and lung function. One patient that was on ECMO prior to transplantation died of multisystem organ failure 100 days after transplantation. Conclusion This study demonstrated the potential for NPOD lung donation. However, utilization rates are low. Therefore, improved strategies of lung preservation before retrieval are required to increase and select lungs that are utilizable for transplantation.